Perceptions de l'organisation et de la pratique des soins buccodentaires en milieu carcéral par les professionnels.

INTRODUCTION: Few studies have been conducted on the role and position of dental surgeons in prisons. Interestingly though, dental surgeons perform in a peculiar working environment, since the organizations are divided into two administrative structures: penitentiary and hospital administrations. Stakeholders’ perceptions of both the current oral healthcare organization in prisons and the interactions between prison and hospital administrations’ professionals will be at the core of this study. PURPOSE OF RESEARCH: This article aims at assessing hospital and penitentiary administration agents’ perceptions of oral healthcare practice in prison. This assessment is based on the analysis of 18 semi-structured interviews with prison directors, integration and probation officers, coordinating physicians and dentists. To do this, three analytical categories were established containing first contextual elements, second each professional culture and last actual and potential interactions. RESULTS: Dentists were identified as specific agents within prison’ sanitary units because of the separation between dentistry and other medical specialties. Indeed, the relation to the body, to self-image and self-esteem along with the specific positioning regarding medical secrecy and expertise required by prison staff make dentistry practice a separate field in prison. CONCLUSION: The results of this study highlight dentists’ specific positioning in prison sanitary units. They could be identified as helpful intermediaries in the building of interactions between penitentiary and hospital administrations thanks to the specificity of the dentistry practice which simultaneously provides health care and promotes the reconstruction of self-image and self-esteem, which are key factors of reintegration.

Knowledge, attitudes and professional practices of ortho-periodontal care of adults: a cross-sectional survey in France.

BACKGROUND: Due to increasing numbers of adult patients, orthodontists are being confronted more and more with periodontal problems. Coordination amongst orthodontists, periodontists and general dentists is useful in preventing and stopping periodontal disease. The main objectives of this survey were to evaluate the technical knowledge, techniques and attitudes employed by French orthodontists, periodontists and general dentists in adult dental care. METHODS: A cross-sectional online survey was distributed to French dentists. The questionnaire, consisting of 30 questions, was divided into six sections covering treatment programs and the forensic environment. RESULTS: One thousand one hundred twenty-two complete answers were recorded. Adults undergoing orthodontic treatment represented 19.9% of the orthodontists' patients, but only 2.67% of the general dentists' patients. Communication between clinicians was rated as good, greater than 3 out of 5. Before treatment, orthodontists were less alarmed than generalists regarding bleeding, recessions, increased probing depths, halitosis and hyperplasia. During treatment, orthodontists never or only occasionally performed palpation or probing in 54.2% and 84.6% of cases. Gingivitis and recessions were the main reasons for consultations for 22.0% and 20.1% of general dentists and periodontists after orthodontic treatment. Of the practitioners surveyed, 43% felt that they experienced a setback in the ortho-periodontal treatment. CONCLUSIONS: This study revealed discrepancies in the knowledge and attitudes of practitioners. Therapeutic management remains one of the major challenges of multidisciplinary treatments. Continuing education needs to be further developed in this field.

Oral Care Needs Amongst Disadvantaged Migrants in France.

BACKGROUND: Disadvantaged migrant populations face risk factors that can affect their oral health amongst other health issues. The purpose of this study was to explore the oral care needs of these populations and to identify the obstacles they might encounter in accessing dental care. METHODS: A cross-sectional study using secondary data was carried out in the Centre Médical Louis Guilloux in Rennes, France, a health centre offering dental consults to migrants. The data were obtained by clinical oral examination and analysed according to various criteria: reason for consultation, diagnosis, treatment plan, drug prescriptions, and referrals to other practitioners. RESULTS: A high prevalence of decay was observed amongst the patients (72.3%). Fifty-nine patients were identified as needing major oral health care amongst the 130 files that were analysed. The lack of proficiency in the host country's language was associated with a major need for oral care (P < .02). CONCLUSIONS: This study highlights that disadvantaged migrants face important oral care needs in France. It suggests alternative actions that should be carried out to improve their access to dental care, including access to interpreting.

Oral Hygiene Practices and Knowledge among Adolescents Aged between 15 and 17 Years Old during Fixed Orthodontic Treatment: Multicentre Study Conducted in France.

The aims of this study were to assess oral health knowledge, attitudes, and practices among orthodontic patients between the ages of 15 and 17 years old compared to adolescents without orthodontic treatment. This cross-sectional study included 392 adolescents drawn from various French teaching hospitals. A closed-ended questionnaire was used to collect data. Adolescents undergoing orthodontic treatment had a higher knowledge of oral health than adolescents without orthodontic treatment. The majority of adolescents for both groups (69%) claimed to brush their teeth twice a day. Regarding complimentary dental material, 81.9% of adolescents without orthodontic treatment never used an interdental brush and 78.8% never used dental floss. For those undergoing orthodontic treatment, 48.5% never used an interdental brush. Only 4% of adolescents without and 3% of adolescents with orthodontic treatment never consumed fizzy drinks, 4.9% and 3% never consumed sweets, and 4% and 8.4% never ate fast-food. Adolescents without treatment consumed more sodas (p = 0.048) and more fast food (p = 0.029). Adolescents had insufficient knowledge of oral health. Health education programmes should be implemented to improve adolescents' knowledge and individual oral prophylaxis with interdental brushes.

Dentists' perspectives on barriers to providing oral health care in French psychiatric hospitals with on-site dental clinics.

OBJECTIVES: Psychiatric inpatients suffer from poorer oral health than the general population, and difficulties in accessing necessary dental treatment remain even when a dedicated dental service is available within the psychiatric hospital. The aim of this study was to identify barriers to access dental care from the point of view of dentists working within French psychiatric hospitals. METHODS: The relatively small number of dentists working in psychiatric hospitals necessitated a qualitative approach. Semi-structured interviews were conducted, recorded, transcribed and coded in a conventional content analysis approach. RESULTS: Eight interviews were conducted. Six of the dentists interviewed were men, and two were women. Three of them worked full-time in a psychiatric facility, while the other five worked partly in the hospital and partly in private practice. The average duration for interviews was 54 minutes (minimum 24 min, maximum 89 min). The interviews highlighted three dimensions of barriers to access to dental care. The first dimension was directly related to the patient. This may be linked to the patient's psychiatric disorder but not necessarily. This also encompasses refusal of care. A second dimension regrouped events related to the organization of the hospital (locally), such as communication issues between staff members within the dental office, and with other staff members from the psychiatric ward. A third dimension included difficulties related to the overall organization of the healthcare system, including financial issues and deinstitutionalization. CONCLUSIONS: In-site dental consultations appear as an interesting tool to enhance access to oral care for psychiatric inpatients. However, difficulties remain from the dentists' perspective.